Practice Rounds: A Weight Lifted

By Gary Pettus

For Elizabeth Beasley, these numbers sum up her long struggle with obesity: the 50 pounds she gained after she had lost 40, her type 2 diabetes, her blood pressure, her countless diets, her 40th birthday.

They all add to this one, perhaps final, hope: bariatric surgery.

Fortunately for her, the bariatric surgery program at the University of Mississippi Medical Center has been revived; Beasley signed up to become one of the first patients to undergo the weight-loss treatment late last year.

“This is not about being skinny,” said Beasley, operations director of the University Physicians Grants Ferry Clinic in Flowood. “This is about being healthy.

“This is about living.”

Five years ago, UMMC suspended its program in bariatric surgery, which is performed on the stomach and/or intestines; for the most part the Medical Center treated patients post-op only.

Dr. Kenneth Vick, associate professor of general surgery, explained: “In this health-care climate, we have to pick and choose where we aim our money and resources. There were other important things we needed to address at the time, including transplants and the care of the pediatric population.”

The other issue: Members of the surgery staff were so good at their jobs, other programs lured them away, he said.

For his part, Vick has been performing bariatric surgery at UMMC’s neighbor, the G.V. (Sonny) Montgomery VA Medical Center, which he’ll continue to do. Now, he’ll also be the surgeon – the only one for a while, at least – in UMMC’s restored program, which has been in the works for a couple of years and will offer surgery to employees first.

The risk of mortality is low, Vick said.

“The rate is less than 1 percent, probably less than one-half percent,” he said. “It’s about the same as a hip replacement.”

All bariatric surgery candidates must lose some weight before surgery, Vick said.

“That’s largely to shrink the liver. When you gain weight, the size of the liver increases and can cover part of the stomach that we usually work on. That increases the chances of damaging the liver during surgery.”

Patients must take psychological tests that reveal their readiness to lose more than just excess weight. They’ll have to shed a few habits as well.

“Surgery is a tool, but it’s not the answer,” said Adam Dungey, administrator of weight management services for the bariatric program.

“You must be willing to make a lifestyle change.”

That means sticking with an exercise program, consulting with dietitians, eating nutritious, healthy meals and more in the years following surgery. It takes 12 to 18 months to achieve maximum weight loss after the operation, which lasts from an hour to 90 minutes.

It’s expensive, and the cost varies widely, from $12,000 to $35,000, according to the National Institutes of Health. Many health insurance plans don’t cover it.

“Patients like Elizabeth Beasley, who are extremely motivated and have a good understanding of the process, tend to make the best candidates,” Vick said. “They understand the surgery is not a cure-all and that it has to be used in the right way to achieve good results.”

The timing couldn’t be better for her and others like her, Vick said, in great part because of the arrival of Dungey.

Before he joined the program on Sept. 1, Dungey was the ambulatory operations director at the UMMC Cancer Institute. For seven years, until 2009, he had built a bariatric program at another Jackson-area hospital.

The benefits of the operation can be tremendous – not only for current patients, but for others in the future.

“As we collaborate with the Mississippi Center for Obesity Research, we hope UMMC can have an even greater impact on the understanding and treatment of obesity,” Vick said.

That impact would be especially striking here in the state that competes with Louisiana as the most obese in the union. Because of that, and in spite of the cost, Dungey is expecting no shortage of patients.

“Our goal is to have 50 the first year, but we plan to do more,” he said.

Bariatric surgery is reserved for people who have tried just about everything else to lose weight, only to gain it all back and more.

“It happened to me once I left my parents’ home,” Beasley said. “My mom had watched every morsel I put in my mouth.”

From her mid-20s on, Beasley’s weight went up and down, finally sticking on up.

“It’s limiting my life,” she said. “I remember this trip to the beach one day. I couldn’t even get in the water and swim.”

Patients like Beasley can expect to lose 55 to 65 percent of excess body weight through the surgery method known as sleeve gastrectomy.

It will be the preferred method here, although Vick also will offer gastric bypass and gastric banding surgery. In any case, to qualify, the patient must have a certain body mass index (BMI), the measure of body fat based on height and weight.

The minimum BMI for bariatric surgery patients is 40 – the number for someone standing five feet, six inches and weighing more than 248 pounds, for instance.

Anyone with a BMI of 35 is also a candidate if obesity-related conditions are present, such as diabetes, high blood pressure, sleep apnea, arthritis, etc. They almost always are.

Those conditions are likely to fade after surgery, Vick said.

“With type 2 diabetes, 70 to 80 percent of patients can see complete remission of the disease.”

This is good news for Beasley, who in her mind sees two images of herself: the one on the beach, unable to dive in, and the one in the water, moving through the waves toward a new life.